Device tip

ABSTRACT

In one aspect of the present disclosure, a device may include a shaft having a distal end, and a tip at the distal end of the shaft. The tip may include an opening defined by a surface of the tip. An instrument inserted through the shaft may extend distally out of the opening. The device also may include an elevator for engaging the instrument. The elevator may include a proximal end fixed relative to the surface of the tip, a proximal portion extending distally from the proximal end, and a distal portion extending distally from the proximal portion. A force exerted on the elevator bends the proximal portion to deflect the distal portion without bending of the distal portion.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This patent application claims the benefit under 35 U.S.C. § 119 to U.S.Provisional Application No. 62/466,657, filed on Mar. 3, 2017, theentirety of which is incorporated herein by reference.

TECHNICAL FIELD

Various aspects of the present disclosure relate generally to tips fordevices. More specifically, the present disclosure relates to endoscopetips for positioning endoscopic instruments.

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique totreat patients with pancreatico-biliary disorders. In some instances,ERCP is performed using a side viewing endoscope. A tip of the sideviewing endoscope may include side viewing optics, an optics lens wash,a side viewing light source, a side exit working channel, and anelevator assembly for elevating an instrument extending out of the sideexit working channel. These features may aid a user in cannulating asubject's papilla, and accessing a target site in the subject'spancreas, with instruments for diagnostic and/or therapeutic procedures.However, elevator assemblies may have complex designs with a multitudeof components, making them expensive to manufacture and maintain (e.g.,clean and/or repair). Reducing the complexity of an elevator assemblymay reduce overall costs associated with using an endoscope. Moreover,when overall costs fall to a certain threshold, it may be practical forthe endoscope to be used as a single-use endoscope. By using theendoscope only once before discarding it, cost and time burdensassociated with maintaining the endoscope may be eliminated, and therisk of exposing a subject to infection through inadequate cleaning ofthe endoscope also may be eliminated, leading to improved outcomes.

SUMMARY

Aspects of the present disclosure relate to, among other things, tipsfor devices. Each of the aspects disclosed herein may include one ormore of the features described in connection with any of the otherdisclosed aspects.

In one aspect of the present disclosure, a device may include a shafthaving a distal end, and a tip at the distal end of the shaft. The tipmay include an opening defined by a surface of the tip. An instrumentinserted through the shaft may extend distally out of the opening. Thedevice also may include an elevator for engaging the instrument. Theelevator may include a proximal end fixed relative to the surface of thetip, a proximal portion extending distally from the proximal end, and adistal portion extending distally from the proximal portion. A forceexerted on the elevator bends the proximal portion to deflect the distalportion without bending of the distal portion.

According to another aspect of the present disclosure, the device mayinclude one or more of the features below. The distal portion may have agreater cross-sectional area than the proximal portion. The distalportion may be thicker than the proximal portion along ananterior-posterior direction, the anterior-posterior direction beingperpendicular to a proximal-distal direction. The tip may be comprisedof a single material. The elevator may be comprised of a singlematerial. An outer surface of the elevator and the surface of the tipmay be portions of a continuous surface. An outer surface of the distalportion of the elevator may be continuous with the outer surface of theproximal portion of the elevator. The proximal portion may have asubstantially straight rest configuration and a bent configuration. Theproximal portion may move the distal portion through an arcuate path inan anterior direction and a proximal direction as the proximal portionmoves from the rest configuration to the bent configuration.

In another aspect of the present disclosure, a device may include ashaft having a distal end. The device also may include a tip at thedistal end of the shaft. The tip may include an instrument opening. Aninstrument inserted through the shaft may extend distally out of theinstrument opening. The tip also may include an elevator for engagingthe instrument as the instrument extends distally out of the instrumentopening. The elevator may include a passage extending therethrough. Thedevice also may include a control wire coupled to the elevator. Aproximal pulling force exerted on the control wire may deflect theelevator. The device also may include a first control wire opening and asecond control wire opening. A first portion of the control wire mayextend from the first control wire opening to the passage. A secondportion of the control wire may extend from the second control wireopening to the passage. A third portion of the control wire may extendthrough the passage to link the first portion of the control wire to thesecond portion of the control wire.

According to another aspect of the present disclosure, the device mayinclude one or more of the features below. A handle at a proximal end ofthe shaft. The handle may include an actuation mechanism for exertingthe proximal pulling force on the control wire. The actuation mechanismmay be operatively coupled to the first portion of the control wire andthe second portion of the control wire to exert the proximal pullingforce simultaneously on the first portion of the control wire and thesecond portion of the control wire. The elevator may include opposingside surfaces. At least one of the side surfaces may include a channelfor receiving at least a portion of the control wire. An opening intothe passage may be in the channel. The tip may include sidewalls onopposing sides of the elevator. At least one of the sidewalls mayinclude a channel for receiving at least a portion of the control wire.The tip may be a one-piece, monolithic, polymer component.

In another aspect of the present disclosure, a device may include ashaft having a distal end. The device also may include a tip at thedistal end of the shaft. The tip may include an elevator. An instrumentinserted through the shaft may extend distally to engage the elevator.The device also may include an actuator to deflect the elevator. Theelevator may include a proximal portion having a proximal end fixedrelative to the shaft. The elevator also may include a distal portionextending distally from the proximal portion. The proximal portion mayhave a smaller cross-sectional area than the distal portion, such that aforce exerted on the elevator may bend the proximal portion to deflectthe distal portion. The elevator may be made of a single, continuouspiece of material.

According to another aspect of the present disclosure, the device mayinclude one or more of the features below. The single, continuous pieceof material may be a single, continuous piece of injection-moldedpolymer. The proximal portion may include one or more indentations, suchthat the proximal portion may have one or more thin regions and one ormore thick regions, to facilitate bending of the proximal portion alongthe one or more thin regions. The tip may further include at least oneportion coupled to the single, continuous piece of material. The atleast one portion may be made of a more rigid material than the single,continuous piece of material. The actuator may include a control wirecoupled to the elevator.

It may be understood that both the foregoing general description and thefollowing detailed description are exemplary and explanatory only andare not restrictive of any claimed inventions.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate aspects of the present disclosureand together with the description, serve to explain the principles ofthe disclosure.

FIG. 1 shows an endoscope, in accordance with aspects of the presentdisclosure.

FIG. 2 shows a perspective view of a tip of the endoscope of FIG. 1, inaccordance with aspects of the present disclosure.

FIG. 3 shows a front view of the tip of the endoscope of FIG. 1, inaccordance with aspects of the present disclosure.

FIG. 4 shows a side view of the tip of the endoscope of FIG. 1 in afirst configuration, in accordance with aspects of the presentdisclosure.

FIG. 5 shows a side view of the tip of the endoscope of FIG. 1 in asecond configuration, in accordance with aspects of the presentdisclosure.

FIG. 6 shows a front view of an alternative endoscope tip, in accordancewith aspects of the present disclosure.

FIGS. 7A and 7B show top and side views of a living hinge of anendoscope tip, in accordance with aspects of the present disclosure.

FIGS. 8A and 8B show top and front views of an elevator, in accordancewith aspects of the present disclosure.

DETAILED DESCRIPTION

The present disclosure is drawn generally to tips for devices, and morespecifically to endoscope tips for positioning endoscopic instruments.Reference now will be made in detail to aspects of the presentdisclosure, examples of which are illustrated in the accompanyingdrawings. Wherever possible, the same reference numbers will be usedthroughout the drawings to refer to the same or like parts. The term“distal” refers to a portion farthest away from a user when introducingan instrument into a subject. By contrast, the term “proximal” refers toa portion closest to the user when placing the instrument into thesubject. The terms “anterior” and “posterior” refer to directions and/orregions extending perpendicular to proximal and distal directions.Though the following description refers to “endoscope” or “endoscopy,”the principles/aspects described herein may be used with any suitableintroduction sheath or device, even if such sheath or device fails toinclude one or more features typically associated with “endoscopes.” Itmay be understood that both the foregoing general description and thefollowing detailed description are exemplary and explanatory only andare not restrictive of the features claimed. Further, as used herein,the terms “comprises,” “comprising,” or any other variation thereof, areintended to cover a non-exclusive inclusion, such that a process,method, article, or apparatus that comprises a list of elements does notnecessarily include only those elements, but may include other elementsnot expressly listed or inherent to such process, method, article, orapparatus. The term “exemplary” is used in the sense of “example,”rather than “ideal.”

FIG. 1 shows a device 100 for positioning an instrument 102. Device 100may be any type of endoscope, such as a duodenoscope. Instrument 102 mayinclude, for example, a guidewire, cutting or grasping forceps, a biopsydevice, a snare loop, an injection needle, a cutting blade, scissors, aretractable basket, a retrieval device, an ablation and/orelectrophysiology catheter, a stent placement device, a surgicalstapling device, a balloon catheter, a laser-emitting device, and/or anyother suitable instrument. In one example, device 100 may to facilitatecannulation of a subject's papilla, and placement of instrument 102therein, during an ERCP procedure.

Device 100 may include a shaft 104. Shaft 104 may include a tube 106that may be sufficiently flexible so as to have the ability to bend,rotate, and/or twist while being inserted into and/or through asubject's tortuous anatomy to a target site in the subject's body. Shaft104 may have one or more lumens (not shown) extending therethrough. Thelumens may include, for example, control wire lumens for receiving oneor more control wires, a working lumen for receiving instrument 102, afluid lumen for delivering a fluid, an illumination lumen for receivingat least a portion of an illumination assembly (not shown), and/or animaging lumen for receiving at least a portion of an imaging assembly(not shown).

Device 100 also may include a tip 108 at a distal end of shaft 104. Tip108 may be attached to the distal end of shaft 104. For example, tip 108may be a cap configured to receive the distal end of shaft 104. Tip 108may include one or more openings that communication with the lumens ofshaft 104. For example, tip 108 may include control wire openings 110and 112 through which one or more control wires may exit from thecontrol wire lumens of shaft 104, a working opening 114 through whichinstrument 102 may exit from the working lumen of shaft 104, a fluidopening or nozzle 116 through which fluid may be emitted from the fluidlumen of shaft 104, an illumination opening or window 118 through whichlight may be emitted, and/or an imaging opening or window 120 forreceiving light used by the imaging device to generate an image. Whilenot depicted in FIG. 1, it should be understood that illuminationopening 118 may include a light emitter (e.g., a light-emitting diode,or the like) coupled to a cable or wire running through the illuminationlumen of shaft 104, and/or imaging opening 120 may include an imager(e.g., a charge-coupled device image sensor, a complementary metal-oxideimage semiconductor, or the like) coupled to a cable or wire runningthrough the imaging lumen of shaft 104.

Control wire openings 110 and 112 may be on a distal-facing surface 124of tip 108. Working opening 114 may be on a distal-facing surface 126 oftip 108. Distal-facing surface 126 may be recessed from distal-facingsurface 124 in a proximal direction. Illumination opening 118 andimaging opening 120 may be on an anterior-facing surface 128. Fluidopening 116 may be on distal-facing surface 124, and may open towardillumination opening 118 and imaging opening 120 to, for example, directa stream of rinsing fluid across illumination opening 118 and/or imagingopening 120 to wash off bodily fluids or debris.

Working opening 114 may open into a cavity 130 of tip 108. Cavity 130may be defined by distal-facing surface 126, lateral-facing sidewalls132 and 134, a posterior-facing surface 136, and an anterior-facingsurface 138 of an elevator 140.

Instrument 102 may extend distally out of working opening 114 and intocavity 130, where instrument 102 may be positioned for engagement withanterior-facing surface 138 of elevator 140. Anterior-facing surface 138of elevator 140 may include, for example, an indentation 168 (e.g., aslot, groove, cavity, or the like) formed therein. Indentation 168 mayreceive at least a portion of instrument 102 to exert a holding orgripping force on instrument 102.

Elevator 140 may be cantilevered, having a fixed proximal end 142 atdistal-facing surface 126, and a free distal end 144. Elevator 140 mayinclude a proximal portion 146 and a distal portion 148. Proximalportion 146 may be thinner than distal portion 148 to facilitate bendingof proximal portion 146. This is because distal portion 148, due to itsthickness, may be more rigid than proximal portion 146. In someexamples, proximal portion 146 may bend while distal portion 148 mayremain unbent.

Proximal portion 146 may have a rectangular cross-sectional shape tofacilitate bending along the anterior-posterior direction. Additionallyor alternatively, a length of proximal portion 146 (along theproximal-distal direction) may be greater than a width of proximalportion 146 (along a lateral direction perpendicular to theproximal-distal direction), and the width of proximal portion 146 may begreater than a height/thickness of proximal portion 146 (along theanterior-posterior direction). Additionally or alternatively, proximalportion 146 may have a substantially constant thickness all the way fromdistal-facing surface 126 to a proximal end of distal portion 148, whereelevator 140 may undergo an abrupt increase in thickness.Anterior-facing surface 138 may be angled (e.g., inclined) relative toproximal portion 146 to facilitate engagement between anterior-facingsurface 138 and instrument 102. Additionally or alternatively, one ormore of a posterior-facing surface of proximal portion 146 and ananterior-facing surface of proximal portion 146 may be substantiallyplanar and/or substantially perpendicular to one or more oflateral-facing sidewalls 132 and 134.

Proximal portion 146 may act as a living hinge to allow distal portion148 of elevator 140 to move relative to the rest of tip 108. Proximalportion 146 may bend such that distal portion 148 may travel along anarcuate path that may cover a distance in a proximal-distal directionand an anterior-posterior direction. In some examples, elevator 140 maybe integral with the rest of tip 108. For example, tip 108, as shown inFIG. 2, may be a single, monolithic, injection-molded component. Tip 108may be made of a polymeric material, such as polyethylene,polypropylene, and/or any other suitable polymer. Tip 108 may be made byany other suitable process, and with any other suitable material, forforming tip 108 as a single piece of the same material throughout.

Distal portion 148 may be thicker than proximal portion 146 to providespace for a passage 150. The thickness of distal portion 148 may ensurethat distal portion 148 does not bend, and that bending of elevator 140is limited to proximal portion 146. Passage 150 may be a through-holeextending between opposing lateral-facing surfaces 152 and 154 ofelevator 140. Passage 150 may receive control wire 122. For example, afirst portion 156 of control wire 122 may extend distally from controlwire opening 110 to lateral-facing surface 152 and passage 150 (see FIG.3). A second portion 158 of control wire 122 may extend distally fromcontrol wire opening 112 to lateral-facing surface 154 and passage 150.A third portion (not shown) of control wire 122 may extend throughpassage 150. First portion 156, second portion 158, and the thirdportion of control wire 122 may form a U-shaped extent of control wire122.

Channels 160, 162, 164, and 166 may be provided in sidewall 132,lateral-facing surface 152, lateral-facing surface 154, and sidewall 134for receiving portions of control wire 122. The received portions ofcontrol wire 122 may slide along channels 160 and 166 as control wire122 is retracted into and/or extended out of control wire openings 110and 112. In the depicted example, passage 150 may open into channels 162and 164. Control wire 122 may be strung through passage 150 bydeflecting elevator 140 in a posterior direction to expose passage 150from behind sidewalls 132 and 134, inserting control wire 122 throughpassage 150, aligning control wire 122 with channels 160, 162, 164, and166, inserting control wire 122 into control wire openings 110 and 112.

By pulling one or both of first portion 156 and second portion 158 ofcontrol wire 122 in a proximal direction, the user may retract controlwire 122 into control wire openings 110 and 112. This retraction maycause proximal portion 146 of elevator 140 to bend as distal portion 148of elevator 140 is drawn toward distal-facing surface 124. FIGS. 3 and 4show views of tip 108 where elevator 140 is at rest, while FIG. 5 showsa view of tip 108 where proximal portion 146 of elevator 140 is bent dueto forces exerted on distal portion 148 of elevator 140 by control wire122. Pulling both of first portion 156 and second portion 158, which areon opposite sides of elevator 140, may ensure that elevator 140 may bedrawn toward distal-facing surface 124 with little or no twisting ortorqueing, to ensure that instrument 102 is brought into a desiredposition.

Instrument 102 may be held in indentation 168 of distal portion 148 asdistal portion 148 is drawn toward distal-facing surface 124. As distalportion 148 is deflected, distal portion 148 may deflect instrument 102,thereby adjusting the position of instrument 102. Instrument 102 may beextended out of, retracted into, and/or rotated (e.g., twisted) in theworking lumen of shaft 104 and working opening 114 before, during,and/or after instrument 102 is deflected by distal portion 148.Continued pulling of control wire 122 may cause distal portion 148 topin instrument 102 against a protrusion 170 on distal-facing surface124. This may lock instrument 102 in place relative to tip 108. Whenlocked, the ability to extend, retract, and/or rotate instrument 102 maybe hindered or eliminated. In one example, protrusion 170 may have ashape complementary to a shape of indentation 168 to facilitate holdingor locking of instrument 102 between protrusion 170 and distal portion148. For example, protrusion 170 may have a wedge-like shape. When theuser ceases to pull control wire 122, and/or extends control wire 122distally, proximal portion 146 may inherently seek to move to its unbentstate, thereby moving distal portion 148 away from distal-facing surface124 and back toward its orientation as shown in FIGS. 2-4. This mayunlock instrument 102.

Device 100 also may include a handle 172 coupled to a proximal end ofshaft 104. Handle 172 may include one or more lumens (not shown) thatcommunicate with the lumen(s) of shaft 104. Handle 172 also may includeone or more ports 174 that open into the one or more lumens of handle172. For example, instrument 102 may be inserted into port 174 on itsway to the working lumen of shaft 104. In one example, handle 172 mayinclude a cable 176. Cable 176 may couple one or more external systems(not shown) to device 100. Cable 176 may, for example, couple handle 172to a fluid supply, an illumination source, and/or an imaging processoror display.

Handle 172 also may include an actuation mechanism 178. Actuationmechanism 178 may include one or more knobs, buttons, levers, switches,and/or any other suitable actuators, for controlling at least one ofdeflection of shaft 104, the delivery of fluid, the emission ofillumination, and/or imaging functions. In one example, actuationmechanism 178 may be operatively coupled to proximal portions (notshown) of control wire 122 that extend proximally from control wireopenings 110 and 112 into handle 172. The user may manipulate actuationmechanism 178 to selectively exert at least one of a pulling force and apushing force on control wire 122 to control the position of elevator140, and thereby control the position of instrument 102.

FIG. 6 shows an alternative embodiment of a tip 108′. Tip 108′ may besimilar to tip 108, except tip 108′ may be made of separate componentscoupled together at a joint 109′. In one example, portions of tip 108′on a first side of joint 109′ may be a single, monolithic component,while portions of tip 108′ on a second side of joint 109′ may be anothersingle, monolithic component. By producing the components separately andthen joining them together, one material may be used for one of thecomponents, while another material (with different properties) may beused for the other component. For example, the component to the left ofjoint 109′ may be made of a material that is more flexible than thematerial used to make the component to the right of joint 109′, tofacilitate bending of the elevator.

In the example shown in FIG. 6, the component to the left of joint 109′may include an elevator, a working opening, control wire openings, adistal-facing surface, a lateral-facing sidewall, and/or aposterior-facing surface, similar to those of tip 108. The component tothe right of joint 109′ may include a fluid opening, a lateral-facingsidewall, an anterior-facing surface, an imaging opening, and/or anillumination opening, similar to those of tip 108. It should beunderstood, however, that joint 109′ may divide tip 108′ in any othersuitable manner. It also is contemplated that joint 109′ may follow astraight line across tip 108′, or may include one or more bends and/orcorners, as it crosses tip 108′. It also is contemplated that joint 109′may divide tip 108′ into more than two components.

FIGS. 7A and 7B show views of an alternative embodiment of a proximalportion 146′ of an elevator. Proximal portion 146′ may have one or moreelements thereon for precisely controlling bending of proximal portion146′. In one example, proximal portion 146′ may include cutouts orindentations 147′ (e.g., notches, grooves, slots, holes, and the like)to facilitate bending by creating thinner portions of proximal portion146′. Additionally or alternatively, proximal portion 146′ may includeprotrusions (e.g., ridges, spines, and the like) (not shown) to limitbending by creating thicker portions of proximal portion 146′. Thecutouts, indentations, and/or protrusions may be on a posterior-facingsurface of proximal portion 146′, an anterior-facing surface of proximalportion 146′, and/or one or more lateral-facing surfaces of proximalportion 146′.

FIGS. 8A and 8B show views of an alternative embodiment of an elevator140′ including a plurality of indentations 168′ and 169′. Indentations168′ and 169′ may have different characteristics. For example, one ofindentations 168′ and 169′ may be wider, deeper, and/or longer than theother. Indentation 168′ may be sized to hold larger instruments, andindentation 169′ may be sized to hold smaller instruments.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the disclosed systems andmethods without departing from the scope of the disclosure. Otheraspects of the disclosure will be apparent to those skilled in the artfrom consideration of the specification and practice of the featuresdisclosed herein. It is intended that the specification and examples beconsidered as exemplary only.

We claim:
 1. A device, comprising: a shaft having a distal end; a tip atthe distal end of the shaft, the tip including: an opening defined by asurface of the tip, wherein an instrument inserted through the shaft mayextend distally out of the opening, and an elevator for engaging theinstrument, the elevator including: a proximal end fixed relative to thesurface of the tip, a proximal portion extending distally from theproximal end, and a distal portion extending distally from the proximalportion, wherein a force exerted on the elevator bends the proximalportion to deflect the distal portion without bending of the distalportion.
 2. The device of claim 1, wherein the distal portion has agreater cross-sectional area than the proximal portion.
 3. The device ofclaim 1, wherein the distal portion is thicker than the proximal portionalong an anterior-posterior direction, the anterior-posterior directionbeing perpendicular to a proximal-distal direction.
 4. The device ofclaim 1, wherein the tip is comprised of a single material.
 5. Thedevice of claim 1, wherein the elevator is comprised of a singlematerial.
 6. The device of claim 1, wherein an outer surface of theelevator and the surface of the tip are portions of a continuoussurface.
 7. The device of claim 6, wherein an outer surface of thedistal portion of the elevator is continuous with the outer surface ofthe proximal portion of the elevator.
 8. The device of claim 1, whereinthe proximal portion has a substantially straight rest configuration anda bent configuration, and wherein the proximal portion moves the distalportion through an arcuate path in an anterior direction and a proximaldirection as the proximal portion moves from the rest configuration tothe bent configuration.
 9. A device, comprising: a shaft having a distalend; a tip at the distal end of the shaft, the tip including: aninstrument opening, wherein an instrument inserted through the shaft mayextend distally out of the instrument opening, an elevator for engagingthe instrument as the instrument extends distally out of the instrumentopening, wherein the elevator includes a passage extending therethrough,a control wire coupled to the elevator, wherein a proximal pulling forceexerted on the control wire deflects the elevator, and a first controlwire opening and a second control wire opening, wherein a first portionof the control wire extends from the first control wire opening to thepassage, wherein a second portion of the control wire extends from thesecond control wire opening to the passage, and a third portion of thecontrol wire extends through the passage to link the first portion ofthe control wire to the second portion of the control wire.
 10. Thedevice of claim 9, further including a handle at a proximal end of theshaft, wherein the handle includes an actuation mechanism for exertingthe proximal pulling force on the control wire, and wherein theactuation mechanism is operatively coupled to the first portion of thecontrol wire and the second portion of the control wire to exert theproximal pulling force simultaneously on the first portion of thecontrol wire and the second portion of the control wire.
 11. The deviceof claim 9, wherein the elevator includes opposing side surfaces, and atleast one of the side surfaces includes a channel for receiving at leasta portion of the control wire.
 12. The device of claim 11, wherein anopening into the passage is in the channel.
 13. The device of claim 9,wherein the tip includes sidewalls on opposing sides of the elevator.14. The device of claim 13, wherein at least one of the sidewallsincludes a channel for receiving at least a portion of the control wire.15. The device of claim 9, wherein the tip is a one-piece, monolithic,polymer component.
 16. A device, comprising: a shaft having a distalend; a tip at the distal end of the shaft, the tip including anelevator, wherein an instrument inserted through the shaft may extenddistally to engage the elevator; and an actuator to deflect theelevator, wherein the elevator includes: a proximal portion having aproximal end fixed relative to the shaft, and a distal portion extendingdistally from the proximal portion, wherein the proximal portion has asmaller cross-sectional area than the distal portion, such that a forceexerted on the elevator bends the proximal portion to deflect the distalportion, and wherein the elevator is made of a single, continuous pieceof material.
 17. The device of claim 16, wherein the single, continuouspiece of material is a single, continuous piece of injection-moldedpolymer.
 18. The device of claim 16, wherein the proximal portionincludes one or more indentations, such that the proximal portion hasone or more thin regions and one or more thick regions, to facilitatebending of the proximal portion along the one or more thin regions. 19.The device of claim 16, wherein the tip further includes at least oneportion coupled to the single, continuous piece of material, and whereinthe at least one portion is made of a more rigid material than thesingle, continuous piece of material.
 20. The device of claim 16,wherein the actuator includes a control wire coupled to the elevator.